Saul N. Weingart MD, PhD looks to the heavens – to airplane cockpits, specifically – for inspiration when it comes to safety in health care. While he’s not a pilot, Dr. Weingart views the intensive work done by the aviation industry to create a culture of safety as a model for what we can achieve in health care.
As vice president for quality improvement and patient safety at the Dana-Farber Cancer Institute prior to joining Tufts Medical Center as its new chief medical officer in July, Dr. Weingart led initiatives to protect the safety of thousands of cancer patients – many receiving high doses of potentially toxic chemotherapy or radiation. Dr. Weingart says he is excited to join the leadership of a full-service academic medical center to help lead the broad changes that will shape the industry as health reform advances. He lives in Newton with his wife and two teenage sons, and has a black belt in Shotokan karate, a Japanese school of martial arts which embraces principles of humility, respect, compassion and patience – skills that are useful in working with more than 500 physicians, nearly 1,200 nurses, regulators and accreditation agencies.
What are you most looking forward to in your new role at Tufts Medical Center?
I think Tufts is ideally suited to make breakthroughs – it is the right size, it has the right level of physician, nursing, and pharmacy engagement, and a capacity to be nimble. It seems to me that Tufts is a jewel that has the promise of reinventing academic medicine. My aspiration is that Tufts Medical Center will become an innovation laboratory for quality, safety and patient experience. It has all the elements that are necessary to make that happen.
When did you first get involved with quality initiatives?
It started during my residency at what was then the Beth Israel Hospital. I noticed that the cardiac monitor-defibrillators would go dead when we brought patients from the ED to the floor, and this happened repeatedly. I looked into the process and it turned out that the monitors were always plugged into the same set of batteries, which wore out quickly, while another set remained charged. This called for a minor process improvement that made these transfers go more smoothly. So naturally I wondered what else we could improve by looking at processes.
The patient safety movement in health care was launched at the first Annenberg Conference in 1996. As a resident I saw an advertisement for the conference and was intrigued. I sent them an abstract about some house staff-sponsored quality improvement projects and they invited me to attend. I was the only resident at the session – there were lots of engineers, some risk management people. I was inspired by what I thought could be achieved in medicine with the types of process improvements described in other industries.
What are some of the key factors hospitals must incorporate to make safety initiatives sustainable?
It can take a couple of years to sustain a new behavior, especially among busy clinicians. One opportunity involves studying the operation of high performing teams, particularly airplane cockpit crews. Part of the reason aviation crash rates are so low is that these teams have worked out how to communicate effectively in the cockpit. They’ve developed a series of tools and skills that needed to be mastered, and they’ve done a lot of work on the culture. The pilot is supposed to invite all members of the crew, including the flight crew in the cabin with the passengers, to speak up if they have a concern. There’s an expectation that everybody has everybody’s back. They also found that simplifying and standardizing operations is the best way of error proofing. We need to find ways in medicine to streamline our work, allowing clinicians to do their jobs more efficiently and reliably.
Is there anything referring physicians can do to help keep their patients safe in the hospital?
It’s important for referring docs to communicate effectively with other care providers, particularly at the beginning of a consultation or admission. Information needs to be shared so that we are all on the same page. On discharge, it’s important to follow up on pending test results, reconcile medications, and ensure that patients get into the office soon after they leave the hospital. We know that these measures prevent errors and reduce readmissions, especially of complex patients. It’s incumbent on the medical center to make sure we get records to the referring physicians in a timely way. Ultimately, it’s all about doing the right things right every time.